Provider Demographics
NPI:1619170438
Name:PUPPALA, VENKATA KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:KRISHNA
Last Name:PUPPALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:903 W MARTIN ST # MS 49-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:210-358-5909
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-2712
Practice Address - Fax:210-358-2802
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48505207RC0000X
TXV3413207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619170438Medicaid
WIK400229776Medicare PIN